Fun Things To Do While Hospitalized

How do you make hospital pharmacist’s head explode?

Ask them what adjustments to make to an insulin pump’s setting when you put the patient on a 5% dextrose (840 ml) with 8.4% sodium bicarbonate (160 ml) IV at 150 ml/hr infusion rate.

It's probably 6.3g/hour; 1ml of pure water weights 1g at about 20C, but you need to check very carefully with the pharmacist or doctor because in some contexts a percentage by number could be used, rather than a percentage by mass. (Also percentage by volume can be used, but not for dextrose.) I'd just ask for the grammes/hour figure; calculation errors are easy and dangerous, I may have made one above.

I hate it when people use percentages in these contexts; it is always ambiguous. The correct unit to use is the 'M", the unit of molar concentration or mM (1/1000 of the mole); the unit used for blood glucose measurement in civilised countries. Accidents happen with percentages.

Once you know the grammes/hour of course it's easy, except that your BG will spike horribly at the start; you really want at least 15 minutes advance notice. For me 6.3g/hour would be about equal to my basal, but if I was sedentary for more than a day my insulin requirement would go up.

John Bowler

Many people that go into the hospital get started on IV fluid replacement. And the standard is some sort of IV that as Bernstein notes "contains some sort of sugar—dextrose, glucose, lactose, lactated Ringer’s solution, fructose, and so on." I think one should ask the doctors to explain the reasoning for putting a patient with diabetes on a glucose drip. Bernstein suggests that you file orders with your hospital such as this one to make sure you aren't inappropriately given a glucose drip. These orders can be filed beforehand and and can be standing orders as part of your health records just like a power of attorney.

Just as much fun: when a meal tray is delivered, ask for a carb count. At one facility, the chief nutritionist was called in and she didn't have a clue. Seems they test BG, give you "the diabetic meal" and shoot you up with an arbitrary bolus.

Their head didn't explode - mine did.

Luckily my wife was available to bring me my meals, when I actually had an appetite that is. I ended up loosing 20 lbs in the eight days I was in. Far, far too many chemicals being introduced to my body to feel like eating much. I counted six meals total.

I wonder how medical people in the hospitals would respond to your recording their explanation why they should hang a bag that would just drive the patient into hyperglycemia. And if I were Bernstein, I’d give them arithmetic for how high the BG will go based on their infusion rate. How is that supposed to help a patient fight off infection or heal from surgery?

It would really be helpful to have a healthy ally/advocate when these decisions are being made.

I'm my own advocate, when conscious. They don't give me squat without my approval. My Wife is there, armed with a medical power of attorney, when I'm not. She's also armed with cell phone numbers of trusted medical professionals (mostly family), for when she needs help.

That's amazing. I was diagnosed around 1974 when I was still living in Coventry (UK, just SE of Birmingham). They had me in hospital for a couple of weeks and I got the special diabetic food from the kitchens; it was part of my treatment, and part of diabetic training because it came with a precise carb count for each part of the meal. I remember the ice cream (proper British ice cream - no cream involved), the only dessert I ever got, came with a 10g price tag and wrapped up in a little roll of wax paper.

I guess I understand, now, why people used to say back then that they remembered when the trains ran on time.

John Bowler